抗结核药物性肝损害172例临床分析

目的：探讨抗结核药应用过程中产生的肝损害问题。方法：对1995年1月～2002年12月住院的1464例肺结核病人，应用抗结核药后出现肝损害的172例患者进行回顾分析。结果：抗结核药所致药物性肝损害(DLL)的高发年龄为20～60岁(70．3％)，消化道症状出现和肝功能改变多发于用药后8周内的强化治疗期，占73，8％，轻者加保肝药治疗可不停用抗结核药，重者须停药并着重保肝治疗，157例(91．4％)恢复正常，13例(7．6％)好转，2例自动出院，41例(23．8％)需减量或停药，对化疗效果产生影响。结论：DLL的发生率为11．8％，体重＜50kg的老年男性、既往已有肝损害或嗜肝病毒感染、饮酒、合并肺外疾病、HRZ三药联用等为易感因素。DLL一旦发生，应及早行保肝治疗。

The Study of 172 Patients with Hepatic Lesion caused by Antituberculotic Drugs

Objective: To explore the liver lesion caused by antituberculotic drugs. Method: 172/1464 cases of the pulmonary tuberculotic patients with liver lesions after the treatment by antituberculotic drugs, who hospitalized in 1995-2002 were retrospective analyzed.Result: The patients aged from 20 to 60 years()70.3%)) have a high incidence of the liver lesion caused by antituberculolis drugs.The symptoms of digestive system and the change of liver function have usually occurred during 8 weeks after treatment ()73.8%)).To the slight patients, the protective liver therapy were applied and the autituberculotic drugs should not be stopped, the serve patients, 13 cases improved,157 cases recovered completely and 2 cases gave up the treatment after stopping these drugs and taking the protective liver therapy. The period of treatment of 41 cases()23.8%)) is disturbed because of the reducing or stopping drug.Conclusion: The rate of DLL is )11.8%) in this study; The old man with the weight<50 kg,the patients with liver lesion, hepatitis virus infected, drinking, combined to extra pulmonary diseases, allied use of HRZ in the past and so on were the induce factor. The protective liver therapy is early carried out with tiopronin and transmetil as soon as the DLL occur.